How Price Responsive Is the Demand for Specialty Care?

Abstract

A significant increase in specialty visit co-payments reduced specialty expenditures among patients obtaining medications at the Veterans Affairs medical centers. Longitudinal expenditure analysis may be improved using recent advances in two-part model methods.

Modeling Semicontinuous Longitudinal Expenditures: A Practical Guide

“…The original study (Maciejewski et al. ) examined whether increasing specialty visit copayments impacted the likelihood of seeing a specialist or the level of specialty expenditures among veterans who did. Annual inflation‐adjusted VA specialty expenditures were constructed for each patient in each year (2000–2003), 2 years prior to, and 2 years after the copayment change.…”

The Intersection of Patient Complexity, Prescriber Continuity and Acute Care Utilization

“…We also examined ER visits and inpatient admissions related to these four cardiometabolic conditions using a similar set of regressions and covariates (age, gender, race (white vs. non-white/unknown), marital status, VA copayment status for outpatient visits and medications, and indicators from the Gagne score 17 ) that were predictive of VA utilization in prior studies. [18][19][20][21] We adjusted for the lagged number of cardiometabolic medications taken to adjust for the possibility of confounding by indication. In a sensitivity analysis, we instead adjusted for the total count of medications and results were similar, so we present results adjusting for cardiometabolic medications.…”

A marginalized two-part model for longitudinal semicontinuous data

“…The data used to assess the impact of this copayment change have been described previously. 27,28 Briefly, 51,503 veterans with hypertension who were diagnosed and prescribed an antihypertensive medication in 2000 at four VA Medical Centers (VAMCs) were identified. Veterans were then excluded if they: (i) were not alive during the entire study period (2000)(2001)(2002)(2003) (n ¼ 7007); (ii) had a majority of their primary care visits outside of these four VAMCs (n ¼ 10,317); (iii) had an unknown military-service-connected disability needed to determine copayment exemption (n ¼ 47); or (iv) were hospitalized when the copayment increase went into effect or for more than one year during the study period (n ¼ 29).…”